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The news about our incredible progress against HIV is only whispered about because there are concerns that if it is emphasised, then people will no longer take care to avoid infection. The HIV charities, full of older gay men who were mobilised by watching their friends and partners die of the disease in the 1980s and 1990s, are left woefully out of touch with the new realities of the disease. For them, HIV will always be the ogre lurking in the shadows, and so any attempt to put it within a wider context of chronic diseases is met with howls about insensitivity or recklessness. They still rely on mobilising outdated fears about the disease to promote safe sex in a way that, for example, diabetes charities never do about eating a healthy diet. By following this old strategy, they inadvertently help to perpetuate the stigma that those with the infection face.

Keep in mind that when a medical doctor makes such a statement it's parochial in the sense of clinical treatment, discounting the mental health aspects and stigma of each disease.

I'll put it this way -- have you ever heard of someone's family forcing a diabetic patient to eat off of paper plates and disposable plastic forks when visiting their home? Yes, I still hear such stories in support groups for people with HIV, even in 2014.

However, it is true that with some people and type-2 diabetes there is a "blame the victim" mindset, but I can't imagine it approaches the level of HIV where it effects intimate relationships because it is sexually transmissible.

The bottom line is I don't think doctors making statements like that are helping anyone -- it's like the "HIV is manageable" statement. Sure, it's manageable for most people but it's still wildly not so for others. Doctors are still jumping beyond what they know, because even for someone who just began HIV treatment in the past five years with what are considered less toxic "good drugs" they do not know what effects they will have 25 years down the road.

I agree with Miss P and do not disagree with most of whats was said by the other posters .

I have diabetes and would rather keep it than the HIV, as if I have a choice LOL ... saying diabetes is worse than HIV is flippant but only meant to show how far HIV treatment has come, once successfully treated HIV is less intrusive from day to day on how we go about our business .

I have to constantly monitor and inject insulin as well as fret about food choices every time I eat . That may not sound like allot but it truly is a bitch to keep up and I end up feeling like I need to do better every single day ... its a nagging constant condition that never relents . When I travel or go see friends I look at my food choices and its rarely adequate and I am left to sigh and say I will do better tomorrow . I could also write pages about what a clusterf**k HIV is .

I also grabbed the wrong vial the other day and overdosed on insulin and had to call 911 ... it was very embarrassing . I had come back from a trip and not separated my quick and long acting insulin as I usually do and got myself in trouble .

Its apples and oranges but I do see bits of truth in both points of view .

The guy is a psychiatrist, so I guess that paragraph shouldn't be a surprise, but I entirely disagree with it. The early Act Up, Silence = Death, etc. protests served their purposes. But now everything I see is related to know your status, testing and outreach, and the old rich gay guys funding the doctors and clinics that provide services for those without insurance or who can't afford treatment otherwise.

Also, I find the article rather useless in the same sense as debating if breast or colon cancer is worse. Either one sucks if you have it, having both sucks more...

My ID doc in Houston said basically the same thing. He was not being flippant IMHO but rather was explaining to someone newly diagnosed how far HIV treatment has come over the years. Poor choice of words, description? Perhaps but I take disease seriously and just feel fortunate to live in the HAART generation.

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Diagnosed in May of 2010 with teh AIDS.

PCP Pneumonia . CD4 8 . VL 500,000

TRIUMEQ - VALTREX - FLUOXETINE - FENOFIBRATE - PRAVASTATIN - CIALIS

Numbers consistent since 12/2010 - VL has remained undetectable and CD4 is anywhere from 275-325

I suppose I should only speak for myself a gay man who is a LTS . I am having a hard grasping what it is that some of us old LTS are accused of not getting, not that its about me or personal , it does not ring true to me and seems more of an assumption than something real .

30 years is a long time and I think a lot of this is simply generational angst .

Interesting article and while I agree that using fear to prevent HIV, is long past its expiration date, in some ways what other options do we really have? Unless your government, is willing to commit to the billions of dollars required, to medicate an ever increasing number of poz folks, your best bet is to reduce infection rates. Parts of this article seem like apples to oranges.

The apples: Nobody debates that the state of HIV care in 2014 is light years from where we started, but who is going to pay for it all? We now prescribe Truvada, not an inexpensive drug, to folks who want to avoid HIV infection? Great idea, but at what cost? Personally, I find the idea of taxing a medical system, for a drug to prevent HIV to be unwise. It takes dollars from actual poz folks and at what point does the system begin to crumble.

When folks tell me that some of my ideals are old fashioned, I do not take offense, however I have seen what happens when you have way too much need and not enough resources to cover everyone. We are facing a different century in terms of HIV resources and there is only so long, that the US can subsidize HIV drug development for worldwide distribution, until cracks start to appear.

As for the oranges, HOW we do HIV prevention is a totally different conversation and folks have been massaging those messages for decades. But the reality has changed. What do you tell someone, to get them to use protection, when they also hear that HIV is no big deal, just a couple of pills and all is good? Better yet, if you are negative, you can take a drug that will all but make you immune to HIV.

Really? Is this the message we want to send? IT IS the message we send and then we get folks who complain that prevention measures are no longer working.

It is not that the prevention messages do not work, it is because we have removed any fear of HIV, that cannot be cured with a couple of pills.

Yes, I would rather have HIV than Diabetes only if I had to make a choice. Amputations don't interest me, nor going blind, which I know can happen with HIV, but not as often as it does with Diabetes.

Perhaps the article will also make some more sense with this info. The Spectater is a Tory mag , that hates money spent on anything other than diplomacy, defence . HIV really collects so much they enjoy poking at . Read the comments and that also helps put it in its context.

I also dislike articles that referr to research but do not note the research .

We are not told what the Doctor,s present job is and his references to his past HIV work experience could be his 6 month training rotation .

I have no disagreement with the fantastic advances but am confused why they are often linked to a attack on Long Term Survivors and the fact that some folk are ill . How inconvenient , such bad manners to hang around ill , spoiling the Party with our ill bodies and histories so so un now .

Please correct me if I am wrong but is not one off the features off HIV is its ability to mutate.

Lastly the article really only is relevent for us members off the rich world. But that's all the Spectator see all else is inconvenient and dam inconsiderate off them. G & T .s all round darlings.

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"If we can find the money to kill people, we can find the money to help people ." Tony Benn

thats helpful for perspective theyer. we have the same thing here. fox news, reich wing conservative bias on all their reporting. not much middle, moderate media here. all too far left or right. i just try to boil it all down and see what remains.

i would rather have hiv than hep c. my mother is in rough shape, me not so much. even with recent trials. i would take it all on from her if i could.

and... this, is so true. i hate this feeling, it has added to my reclusive nature

"How inconvenient, such bad manners to hang around ill, spoiling the Party with our ill bodies and histories so so un now."

[color=green I agree with this doctor's opinion. I have literally said "I'd rather have HIV than Diabetes" in 2006 after my mom was told she had Diabetes. My mom tried to compare her disease to mine and said Diabetes was not as bad since it is not an STD. Occasionally she goes into a coma type sleep for 10-24 hours after one meal of rich foods. All four of us kids had to take turns checking on my mom while she slept. Yet I am the one with HIV. I do not have any related illnesses, thank goodness. My mom has had her share of complications, she sees four different specialists and a physician. She still only takes oral meds for her Diabetes, but also takes meds for her heart, kidney, lungs (inhalants), and liver. Her best friend also has Diabetes and lost her foot to a blood clot. They have acted like it is nothing compared to my HIV virus in an attempt to make me feel bad, but they are more annoyed by the fact I was suppose to die of AIDs back in '96 or '97. I was not given long when I first saw a doctor. The dumb part of my mom's comments about my catching HIV is she does not think before speaking. I was infected by the first man I was with, I never had been with anyone before him and we were engaged. My mom was warned repeatedly about the possibility of becoming a Diabetic since they performed many types of tests periodically after her first heart attack.

Keep in mind that when a medical doctor makes such a statement it's parochial in the sense of clinical treatment, discounting the mental health aspects and stigma of each disease.

I'll put it this way -- have you ever heard of someone's family forcing a diabetic patient to eat off of paper plates and disposable plastic forks when visiting their home? Yes, I still hear such stories in support groups for people with HIV, even in 2014.

However, it is true that with some people and type-2 diabetes there is a "blame the victim" mindset, but I can't imagine it approaches the level of HIV where it effects intimate relationships because it is sexually transmissible.

The bottom line is I don't think doctors making statements like that are helping anyone -- it's like the "HIV is manageable" statement. Sure, it's manageable for most people but it's still wildly not so for others. Doctors are still jumping beyond what they know, because even for someone who just began HIV treatment in the past five years with what are considered less toxic "good drugs" they do not know what effects they will have 25 years down the road.

Kindest regards,

Cranky Gay Ogre

I have lived long enough with the virus to see I currently have no side effects I was told I might have. I liked this article since it is something in support for us HIV infected people. I understand your point. It took almost nineteen years, but my littlest sister stopped following me around with bleach-sponge or Clorox wipes when I use the bathroom. She now eats what I cook as well off of dishes I washed. My relationship is good with my two younger sisters. I enjoy my life today. I thank people who stand up for us like this doctor who made this statement.

lol, i cut myself chopping some veggies the other night. i sprayed the floor with simple green, wiped it up with a paper towel, and went on cooking... my father came behind me with clorox, mopped the whole damn kitchen like a super fund site. at first i was offended, then just figured whatever floats your boat, the floor is clean now

I had an uncle that was scared my aids was going to slither up upon him and the whole family myself included used to have fun at his expense . Men in my family ( except me ) never hug other men . When I would see my uncle come in I would walk towards him hacking and coughing for a hug so we could all watch him turn green .

I had an uncle that was scared my aids was going to slither up upon him and the whole family myself included used to have fun at his expense . Men in my family ( except me ) never hug other men . When I would see my uncle come in I would walk towards him hacking and coughing for a hug so we could all watch him turn green .

Had to be hard to keep a straight face. I would just eventually lose it.

I have heard many say that. And, I've thought about that. If Morgan Freeman showed up and said I had a choice, I'm not sure what I would do.

I did just read this response from Dr. Gallant. A medical student asked how he would counsel someone newly diagnosed. I began thinking he's right. But, how many pozzies will eventually get all the ailments he lists as far worse, which can be linked to the virus or meds? So, they have HIV on top of the others. I suspect, from the minimal knowledge I have, that those issues happen primarily to those who took the very toxic meds of the past and all those who barely made it for HAART, where their bodies had already suffered so much damage??

"As an HIV doctor, the patients who come to me have already been informed of their diagnosis by someone else. The important thing in counseling someone who has just been diagnosed with HIV infection is to remember that the emotional implications may be greater than the medical ones.

Medically, you could argue that it would be worse to have diabetes, rheumatoid arthritis, or a cardiomyopathy than to have HIV infection. We can treat HIV effectively with just one pill per day, often with little to on impact on quality of life or life expectancy. The same cannot be said for those three diseases, or many other chronic medical conditions,

However, people who find out they’re HIV-positive may react much more emotionally to their diagnosis than they would with other chronic diseases. They may be experiencing shame or guilt over having acquired a preventable disease. They may be angry at the person who infected them. They may be worried about confidentiality because of the stigma associated with HIV infection and the risk behaviors that result in infection. Finally, they may have fears based on an outdated understanding of the prognosis for HIV-positive people.

You can deal with some of these emotions through education: teaching them that the treatment for HIV disease is much easier and the prognosis far better than in the 80’s and 90’s. It can be a lot harder to deal with shame, guilt, anger and fear of stigma in a single counseling session. Ongoing counseling or support groups can be very helpful, especially for people who don’t have good support among their own family and friends."

Never known diabetes to be criminalised the same way being HIV poz is.

Never read a personal advert saying 'diabetes negative UB2'.

As for a lot of the rest, having HIV strongly influences when and what I eat, my exercise regime, making sure I get the right amount of sleep, disclosure issues mandated by law, neuropathy, extra work mediating depression, extra monitoring for non Aids defining cancers and so forth...

I'm not saying diabetes is simple but HIV is not as simple as taking a pill. Just because we've become accustomed to the routine doesn't mean that it a walk in the park.

I think it's a very dangerous, pointless and unmeasured statement to make. There are too many variants such as age, socio-economic class, country of living, length of time since diagnosis, treatment time etc to be able to make such a wide and sweeping statement that 'Diabetes is worse than HIV'.

Also, I do not believe that a person, regardless of whether they are a Doctor or not, have the moral right or authority to make a statement on which disease is worse, if that person is not living with either disease. How can he draw such conclusions? Is this from experience with living with either or both disease. The answer is no.

So any assumptions are just that - 'an assumption'. It's not factual. Both diseases are extremely nasty. I live with HIV and also bare witness to my brother that also lives with Type 1 diabetes. It too is an awful disease. He has to contend with Hypos, collapsing on the street or in public and going into a fit. It's awful. I would say on a day to day basis diabetes is far more intrusive. However, if you interview someone contending with the ravages of HIV disease, he could argue HIV is worse.

I'm not here to make judgement. After all, it's a pointless exercise. But what I will agree with is that HIV is more manageable now than it was 15 years ago. Things have improved, but what remains to be seen is whilst we may live longer, what will the quality of our lives be? That's what matters to most - quality. I don't want to live longer if it means i'll be hooked up to tubes and living in a bed.

All we can hope for is that as time goes on, we will see more improvements in HIV treatment. Until then, these articles are 'sensational' at best and don't serve any purpose apart from maybe giving us HIVers that we can live a long and normal life hopefully.

Unless your government, is willing to commit to the billions of dollars required, to medicate an ever increasing number of poz folks, your best bet is to reduce infection rates. Parts of this article seem like apples to oranges.

I think 2018 will be a watershed moment for this, assuming we don't all become resistant to Atripla or Truvada. Generic Atripla will become as cheap as USD400/year and Truvada for PEP could be as cheap as USD25/month (currently that's what the Thais pay). Hopefully that should convince governments (other than just the UK) that running 'test and treat' campaigns are much more cost effective than running 'scare and prevent' campaigns. It is already shown scientifically that PEP does work, and viral load supression does prevent HIV infections.

In the long run, govs won't actually need to 'medicate an ever increasing number of poz folks'. Putting everyone on medication and PEP should keep the number of poz folks stable.

you can't possibly see a future where everyone is taking ARVs all the time, regardless of status?! jeez, here in america there is a huge backlash against simple vaccinations. people have forgotten mumps, polio, etc. all because of some bunk story back in the 80s about vaccines, mercury, and autism. and jenny mccarthy's nice rack is so distracting

i just don't see everyone agreeing to be medicated as prophylaxis. nor do i see the need. thats not the right answer.

are much more cost effective than running 'scare and prevent' campaigns.

'scare and prevent' campaigns have already done wonders with tobacco usage reduction and HIV prevention, so don't diss them out of hand. How do you think America got down to 50K new infections a yr? One method was "scare" campaigns which did quite well

I do not see it as scare campaign's, I see facts being offered . The new meds and testing technology's are great innovations but we already see folks showing up poz from using oraquick test to test tricks and serosort not knowing the limitations and window periods have given some people false sense of security .

Also ... I have heard people start to say since treatment is prevention and undetectable means no transmission do I still have to talk about HIV . These are tools in an arsenal of treatment and prevention and not a path back into the closet .

sure it did. that's what helped it get down to 50k a yr. It's just not the panacea for the problem. scare tactics still need to be used because they prevent some people (yes, not all; but there is no one solution to reach ALL people) from getting infected.

all "just say no" campaigns work to some extent. Just not enough to change the behavior of all people. That doesn't mean "just say no" doesn't work or that it should be discontinued. Don't throw the baby out with the bath water for goodness sake.

It's like the PrEP/truvada "controversy". there is NO controversy. PrEP clearly will help. So will TasP (treatment as prevention). Neither one should be ruled out and both should be used. Just don't expect either one alone to solve the issue.

I agree, I just personally dislike the scare campaign so much. And, as the author of the article points out, I agree that it has contributed to the stigma associated with HIV.

However, unlike the author, I think it's more complicated. The fact that it affected mostly gay men really set the ball rolling in marginalizing those affected with HIV that someone affected with say Diabetes isn't. That wasn't touched in the article.

I wish he titled his article differently. He brings up some good points in how hiv is approached differently than other diseases that adds to its stigma (including scare tactics still used today). But, some of the message gets lost in personal comparisons.

However, unlike the author, I think it's more complicated. The fact that it affected mostly gay men really set the ball rolling in marginalizing those affected with HIV that someone affected with say Diabetes isn't. That wasn't touched in the article.

I wish he titled his article differently. He brings up some good points in how hiv is approached differently than other diseases that adds to its stigma (including scare tactics still used today). But, some of the message gets lost in personal comparisons.

I think this is all rather silly, I mean I'd rather eat an orange than an apple says nothing about the taste, texture, etc of either fruit and really means nothing at the end of the day. Same thing for HIV vs. Diabetes. People do well with either and people die from both.Besides -- why would one need to choose?? who the hell chooses anyways......

Although, as for the "scare" campaign -- not a fan of it. What is needed is transparency. Living with HIV isn't what it used to be for most folks who have consistent access to HAART, but it still kills and it still disrupts lives in any number of ways - more so for some than others. Same for Diabetes. Same for lots of other "chronic illnesses".

I do question, though, whether it is the scare campaign that has maintained the 50K new cases per year for the last 20 yrs. HAART has been here and "improved" in that time, so, in theory, cases should have come down more, but they haven't. It's not as simple as saying "scare campaign works" -- it DID work at one time (there weren't many other options), is it working now? Not sure we can parse that out given the impact of treatment. Without successful treatment, would we still be at 50K/yr - I have my doubts?

I agree with bocker basically its apples and oranges and people should understand and live well with both, without ranking. Also the poster above who spoke about colon vs. breast cancer. I mean WTF. HIV+ people and public health workers and epidemiologist can explain living with HIV 2014 and really there is no need to rank diseases. That said, I'm sure doctors would like to calm the panic and give perspective, and comparisons of diseases in a doctor's mindset is probably pretty different than for us laymen.

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“From each, according to his ability; to each, according to his need” 1875 K Marx

Looking at HIV clinically, I think it's pretty easy to see how a doctor (or anyone for that matter) may reasonably state it can be "preferable" over some other conditions, especially when caught early and treated following current recommendations:

it's got an effective treatment

the treatment is generally simple

expected life span is pretty much normal

there is relatively few if any (physical) limitations caused by it

Of course we are more than just our physical selves, metaphorically speaking. We have emotional selves, and live in the social context of society. We must be able to afford treatment, adjust to stigma, and deal with all the non-clinical aspects of living with a disease that is associated with sexual transmission, drug use, and the gay community, even if you are not gay.

In this aspect, I think HIV can be more difficult. I just don't view that as caused by the disease as much as by society. As always, individual experience may vary in both the clinical outcomes as well as in the emotional ones. But on the whole, I think the above is true.

It further caries into other aspects.

The very same reasons that HIV carries stigma, plagues the effectiveness of prevention programs. Abstinence programs have poor results in avoiding pregnancy and STDs. One of the most common findings is that "participants" are still sexually active in high numbers, but don't plan on using protection because that would be planning on "failing". Yet proponents of abstinence programs often say that promoting condom use is promoting sex.

Similarly, PrEP faces many challengers who say it promotes condomless ("unsafe") sex. Like those teens who may try to take steps to protect themselves, they are "slut shamed".

In both cases, they are not after better outcomes based on data, they are actually after enforcing behavior. The two are not the same and when policy analysis is done I think that is clear.

Looking at HIV clinically, I think it's pretty easy to see how a doctor (or anyone for that matter) may reasonably state it can be "preferable" over some other conditions, especially when caught early and treated following current recommendations:

it's got an effective treatment

the treatment is generally simple

expected life span is pretty much normal

there is relatively few if any (physical) limitations caused by it

Yet here is the flaw in this logic.

Everything you state may be true in general, it is not universally true for any particular person.

Effective treatment is NOT available for everyone -- WHO estimates 1.6 million died in 2012."Simple" treatment doesn't matter if it isn't availableLifespan is theoretical at this point -- HIV hasn't been around, with effective treatment to say that with surety.Many folks have limitations due to HIV and/or it's treatment. (HIV related diarrhea comes to mind, as do diet restrictions for folks dealing with high lipids from treatment)

There is no "reasonable" comparisons between chronic diseases at the individual level, IMO. It's all hogwash -- the actual preferred choice is "I'll choose NEITHER", thank you very much.

Again -- what is the point of comparison?? it's a "feel good" thing that actually doesn't hold true for everyone.

It's no wonder some people are ridiculed as being sluts when PrEP allows someone to have a "safe" version of bareback sex. (using condoms AND PrEP seems like overkill) It seems that promoting condomless sex as safe sex would make the prevention message much more confusing for the uneducated layperson.

There is no "reasonable" comparisons between chronic diseases at the individual level, IMO. It's all hogwash -- the actual preferred choice is "I'll choose NEITHER", thank you very much.

Again -- what is the point of comparison?? it's a "feel good" thing that actually doesn't hold true for everyone.

For an individual patient, I agree. For us, comparisons of what poison to choose make little sense.

From an economic perspective, the cost of managing diabetes and its complications would eclipse that of HIV. If it weren't for the cost of ART's. We can blame pharma partially for that, even after accounting for recovering research costs.

From a doctor's perspective, it's a sad game. But one played commonly by health professionals. My take: at least it shows some progress in the medical community's perspective on HIV as a chronic, and not fatal, disease. It also reflects on how much more frequent diabetes is seen by doctors in hospitals. And how much more poorly diabetics do (Google diabetes and hospital morbidity or mortality).

Lastly, not all diabetics and HIV are created equal. As are their different stages / severity. There will always be extremes.

And let's face it. As patients, we care mainly about what happens to ourselves.

leather, i understand what it is... just not really the thinking behind it. it was a throwaway comment, i probably shouldn't have posted

prep, by definition, is choosing to have unprotected sex with a positive partner. relying on a med, and UD VL statistics, to have the increased "intimacy?" of bareback sex? i don't judge those that do, consenting adults so game on. twisted logic to me, its seems an unhealthy way of thinking

this sort of touches on something that has been talked about in another thread. are some people really advocating neggies to go on meds, permanently?

this sort of touches on something that has been talked about in another thread. are some people really advocating neggies to go on meds, permanently?

Sure. Some doctors and epidemiologists think its reasonable for "populations at risk" to take PreP. That is to say gay men who have a lot of sex, lot of partners, and don't always use condoms, for example. Also, doctors prescribe PreP to people in relationships with HIV+ partners, for a few different reasons.

But maybe you meant, by permanently - like forever. In that case I'm with you I haven't heard and buzz on PreP being a permanent thing. I thought to date it was situational. I suppose it could be years and years depending on the individual situation.

But maybe its another thread. Its controversial and needs talking out when it comes up in conversation.

« Last Edit: April 18, 2014, 05:38:29 AM by mecch »

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“From each, according to his ability; to each, according to his need” 1875 K Marx

I do not see it as scare campaign's, I see facts being offered . The new meds and testing technology's are great innovations but we already see folks showing up poz from using oraquick test to test tricks and serosort not knowing the limitations and window periods have given some people false sense of security .

Also ... I have heard people start to say since treatment is prevention and undetectable means no transmission do I still have to talk about HIV . These are tools in an arsenal of treatment and prevention and not a path back into the closet .

In a 'test and treat' campaign, testing negative within the window period just means being suitable for PEP, not that they're off the hook. I also don't see why that can't be offered to people who had insignificant/zero risk encounters. At least to get the general populace used to the idea of PEP after unprotected sexual activity. Like morning after pills. Or rabies shots after dog bites. I know there's the increased risk of viral resistance and maybe more accurate tests could help. But in principle, prevention of HIV through condoms perpetuates stigma because it requires people to asses risk before the act is done, whereas PEP lets you do that after and without any confrontation. We've heard all of this before, wife asks philandering husband to use a condom and husband yells back 'What? You don't trust me??'.

meech, i hear you, but either way i find it bent logic on the part of the negative in regards to prep

scenario 1... "i want to have unprotected sex with a positive partner. therefore i'm going to take this super expensive med simply to bareback"--- ok fine, if they only take it prior to said sex acts, wouldn't that increase the risk of developing a resistance should they decide to do it again, and again (cause once you go that way, its so cool you'll do it again)? or worse, if they are ever infected and require the med, seems a horrible waste if they've already developed resistance

scenario 2... "i don't have this virus. i'm going to take this super expensive med to protect myself. instead of wearing an inexpensive condom." i guess access to condoms in some areas is a challenge. but would people in those areas really have easier access to ARVs than a condom?

something about all this just doesn't lead from point a to point b, for me. and it does not seem the best course of action in education or prevention. it encourages high risk behavior

pep i view differently, and can really see the value of. a person has a known exposure, and the now tools to prevent infection from taking hold. but prep, i dunno, seems like playing roulette with all six rounds, only most are blanks, y'all g'head i guess

and you're right, its something that needs to be talking about, and hammered out. maybe i'm wrong headed about it. maybe there is a rationale i haven't considered or perspective i'm just not seeing

A person doesn't take PreP for one off situations. Hypothetically, lets say a gay dude goes in for an HIV STD screening in Atlanta and a doctor or nurse talks about the persons sex life and its established there is a fair amount of risk. PreP could be prescribed and the person would take it every day going forward, for as long as the behaviour includes risk. Months. Years. Not the weekend... Yep, someone is paying for it.Yep, there are arguments on both sides about it all. Yep, condoms are cheaper. But lots of people don't manage to wear condoms and are committed to having an actual sex life, on their terms and rules, and PreP is cheaper than an HIV infection for life, so..... Also, the person would not get HIV. Cost is hardly the only consideration.

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“From each, according to his ability; to each, according to his need” 1875 K Marx

Perhaps we can expand this thread title to include; I'd rather have any other STD or become pregnant than have HIV". PEP and PrEP do nothing to address those issues.

One of my dates in Chicago was dumbfounded that I insisted on safer sex since we're both UD pozzies. Other than knowing what bar he hangs out in and that he was hot, I knew nothing else about him. Imagine acquiring a coinfection after all this time because of the wrong messages that are voiced.

Different situations require different courses of actions.

Perhaps that's why I was a bit flippant earlier as I couldn't exactly understand the mindset of random bareback sex since we MIGHT be able to not become positive for HIV. I'll continue with condom use until I'm in a committed relationship or with someone I know on an intimate enough level to trust them. Even that's no guarantee, but HEY!!! We all like some bareback now and then.

Everything you state may be true in general, it is not universally true for any particular person.

Efective analysis cannot be based on a particular person anymore than anecdotal evidence proves a theorem.

Policy analysis requires comparison of things at a broader level. Of course diseases and their teatments can be compared. That is done all the time for funding.

We also adjust approaches based on resources. I'd rather be in a first world country for living with pretty much any condition over having to manage it elsewhere. That still doesn't change the validity of the physician's comparison.

Personally I think it's a great article. I also think that its perfectly appropriate to compare the two diseases in the context of discussing stigma.

When the old equation HIV=AIDS=DEATH was still true, the scare campaigns were on target and quite effective. They helped scare me into abstinence thru my high school/college years back in the late 80's - early 90's.

But what we really need today is to get people tested regularly and onto treatment. The PARTNER study just released pretty much proves that the virus is not being spread by undetectable pozzies. The virus is being spread by people not on meds. How many of those suspect their status, but resist testing because they fear the stigma and prefer not to know? I read stories like that all the time on here. If there was less stigma, would there be more testing/treatment, hence less transmission?

The reality of HIV in 2014 is that while it remains expensive to treat, it's pretty easy to live with. Suppressing that message helps keep people fearful of the disease, but it may have outlived its effectiveness as a prevention strategy.

How many of those suspect their status, but resist testing because they fear the stigma and prefer not to know? I read stories like that all the time on here. If there was less stigma, would there be more testing/treatment, hence less transmission?

That is essentially my story. I suspected but was afraid to get tested because I did not think I could mentally handle the results. That fear was the result of the HIV=AIDS=DEATH scare tactics. I agree with you that more people need to get tested but we still have a pretty steep hill to climb for not freaking people out.

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Diagnosed in May of 2010 with teh AIDS.

PCP Pneumonia . CD4 8 . VL 500,000

TRIUMEQ - VALTREX - FLUOXETINE - FENOFIBRATE - PRAVASTATIN - CIALIS

Numbers consistent since 12/2010 - VL has remained undetectable and CD4 is anywhere from 275-325

Efective analysis cannot be based on a particular person anymore than anecdotal evidence proves a theorem.

Policy analysis requires comparison of things at a broader level. Of course diseases and their teatments can be compared. That is done all the time for funding.

We also adjust approaches based on resources. I'd rather be in a first world country for living with pretty much any condition over having to manage it elsewhere. That still doesn't change the validity of the physician's comparison.

Well -- it does, in fact change the validity, as he was talking about a person, not a cohort. The title of the article points to it being based on why HE would want HIV over Diabetes.

I have a Masters in Public Health - don't need your lecture on policy analysis -- but thanks for playing.

I stand by my opinion, that his opinion of which disease is "preferable" is of no use to anyone else. His comparison works for HIM, not necessarily for others.

Personally I think it's a great article. I also think that its perfectly appropriate to compare the two diseases in the context of discussing stigma.

Yes -- appropriate to compare, I think the message of hope for the newly infected is important -- assuming that sustained treatment is an option for them. Not all that helpful to say one is preferable to the other.

Well -- it does, in fact change the validity, as he was talking about a person, not a cohort. The title of the article points to it being based on why HE would want HIV over Diabetes.

I have a Masters in Public Health - don't need your lecture on policy analysis -- but thanks for playing.

I stand by my opinion, that his opinion of which disease is "preferable" is of no use to anyone else. His comparison works for HIM, not necessarily for others.Yes -- appropriate to compare, I think the message of hope for the newly infected is important -- assuming that sustained treatment is an option for them. Not all that helpful to say one is preferable to the other.

M

Then our educations lead us to different conclusions as my policy background finds no issue with his discussion as he intended it. His comparison works for him and those in similar situations, which are not insignificant numbers of those living with access to healthcare.

lol, i cut myself chopping some veggies the other night. i sprayed the floor with simple green, wiped it up with a paper towel, and went on cooking... my father came behind me with clorox, mopped the whole damn kitchen like a super fund site. at first i was offended, then just figured whatever floats your boat, the floor is clean now

OMG I was dying laughing reading that! I was 5 mos. pregnant when I was diagnosed and had to move back home before I had the baby because I lost my apartment. My parents were so paranoid I had to bleach EVERY damn thing. To this day 2 decades later I still bleach everything to death even though I'm sometimes the only one in my home. Smells like a hospital in here but dammit it's sanitary! But I will say though that they have loosened up a bit about it. They eat when I cook for family occasions and no one freaks out about doing my dishes. I'm the one who's neurotic...how f*cked up is that??

Then our educations lead us to different conclusions as my policy background finds no issue with his discussion as he intended it. His comparison works for him and those in similar situations, which are not insignificant numbers of those living with access to healthcare.

I agree that,s why its such a Political article and a disposable one also.

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"If we can find the money to kill people, we can find the money to help people ." Tony Benn

In the long run, govs won't actually need to 'medicate an ever increasing number of poz folks'. Putting everyone on medication and PEP should keep the number of poz folks stable.

?Can you expand on this please.

I'll chime in on this. I currently sit on the New Hampshire HIV Planning Group (HPG) advisory committee. This basically a group that has to be in place to for the state to get Ryan White/ADAP grants money. I recently wrote a paper on HIV as a social problem. It predicted that gay/bisexual man who is 18 now has a 2 in 5 change of being HIV+ by the time they reach 40 and it showed that gay/bi sexual men age 13-24 account for 57% of all new HIV infections. It was about 5-6 years ago the state, along with many other states, cut funding to outreach and other preventative measure as these things were not showing a "return on investment" The CDC and any states redistributed funds toward other programs for HIV.

We had a discussion on this subject and basically what came out is that the state would rather just promote getting tested, know your status, and for those that test + get them on treatment. in their eyes it is more "cost effective"

Yes there are some older HIV medications that will be available as generic and at a much reduced cost. So yes in the eye of the government they are not looking to prevent, but treat person with HIV

When the old equation HIV=AIDS=DEATH was still true, the scare campaigns were on target and quite effective. They helped scare me into abstinence thru my high school/college years back in the late 80's - early 90's. But what we really need today is to get people tested regularly and onto treatment. The PARTNER study just released pretty much proves that the virus is not being spread by undetectable pozzies. The virus is being spread by people not on meds. How many of those suspect their status, but resist testing because they fear the stigma and prefer not to know? I read stories like that all the time on here. If there was less stigma, would there be more testing/treatment, hence less transmission?

Yes I agree with what you are saying here. My opinion may be slightly slanted towards the LGBT community as I am member of this community. The LGBT community needs to embrace all those in the community and stop Othering within our community. If the LGBT community would all get behind an anti-stigma campaign as it has with marriage equity it would do a lot to reduce these stigmas. We need to change the mindset of people and those that are strong need to speak up and advocate when they here wrong or false information. It's going to take a strong group of HIV positive(or negative) people to stand up and talk about HIV! The more we hide and are scared the more these stigmas will hold on and keep us down.

" It is the fear of being ostracised that is the biggest problem for those who are newly diagnosed, not the virus itself."

As a newly dx'd, I disagree. I care WAY more about the virus and the impact to my health and life span than I do any stigma. Wtf.

None the less, I did contemplate if I rather have HIV or cancer (pple battling in my f and have died from) and really couldnt come up with an answer. I was just trying to myself feel better I guess.

I rather have a puppy too. An Akita.

Hello,

I think you speak for many who are diagnosed.

Now the important bit do you realize how much exercise an Akita needs to maintain good mental health , 2 hours min a day. The same as my Jack Russell, but I can scoop up Miss Miasofia and descend into the underground , try doing that with Betsy - Lu the Akita .

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"If we can find the money to kill people, we can find the money to help people ." Tony Benn

I'll chime in on this. I currently sit on the New Hampshire HIV Planning Group (HPG) advisory committee. This basically a group that has to be in place to for the state to get Ryan White/ADAP grants money. I recently wrote a paper on HIV as a social problem. It predicted that gay/bisexual man who is 18 now has a 2 in 5 change of being HIV+ by the time they reach 40 and it showed that gay/bi sexual men age 13-24 account for 57% of all new HIV infections. It was about 5-6 years ago the state, along with many other states, cut funding to outreach and other preventative measure as these things were not showing a "return on investment" The CDC and any states redistributed funds toward other programs for HIV.

We had a discussion on this subject and basically what came out is that the state would rather just promote getting tested, know your status, and for those that test + get them on treatment. in their eyes it is more "cost effective"

Yes there are some older HIV medications that will be available as generic and at a much reduced cost. So yes in the eye of the government they are not looking to prevent, but treat person with HIV

Well lucky ole drug companies and Hospitals.

I find the above facts profoundly depressing , but am not surprised , I cannot see History judging these decisions well , in fact they are in my view madly optimistic , a feature off the HIV virus is its ability to mutate , and I do not think it is doom mongering to want to see a human beings life time,s worth off statistics before claims are made for anything up to today.

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"If we can find the money to kill people, we can find the money to help people ." Tony Benn